Measles is a viral disease characterized by a number of unpleasant consequences and complications and enters the body through the respiratory tract, mucous membranes of the nose and mouth. Measles was described as a separate disease in the 17th century, but there is still no etiotropic treatment aimed at eliminating its cause. The doctor prescribes individual treatment for each patient, which can only alleviate the symptoms. But one of the features of the course of this disease is a very high degree of transmission from a patient to a healthy person, almost 100%. At the same time, at the initial stage, measles can occur with mild symptoms, and the incubation period in an adult lasts up to a month. But most often children of preschool and primary school age get measles.
The only way to prevent health damage today is measles vaccination. The first vaccinations were tested 300 years ago, but researchers are still working on new vaccines, creating an increasingly effective and long-lasting drug. Nina Yandraykina, a pediatrician at the MEDSI children's clinic on Pirogovskaya, talks about the characteristics of measles in children and which measles vaccination for children would be optimal in modern conditions .
Federal News Agency / Photos courtesy of Nina Yandraykina
Measles is a truly dangerous disease, and above all because in most cases it occurs with pronounced symptoms, which in themselves are painful for the child: if it is a temperature, then it is very high, up to 39–40 degrees, if it is a cough, then it is sharp, irritable, if conjunctivitis, then with swelling of the eyes and photophobia. General symptoms are also clearly expressed - severe weakness, loss of appetite, headache, and sometimes vomiting, delirium, and convulsions can even occur.
“Measles is also dangerous because, even without complications, it sharply reduces immunity. Researchers have proven that the measles virus leads to T-immunodeficiency, that is, to a deficiency of cells that create immunity. This state of “anergy” lasts about a month after the illness itself and can cause the development of other diseases,” says Nina Yandraykina.
Complications from measles are also not simple - they are pneumonia, otitis media, laryngitis, stomatitis, and severe encephalitis. Laryngitis can occur with measles croup. The impressive list of complications continues with hepatitis, pancreatitis, thrombocytopenic purpura (ITP, primary immune thrombocytopenia, Werlhof's disease - an autoimmune blood disease), hemorrhagic syndrome - skin hemorrhage, bleeding of the mucous membranes, pericarditis, myocarditis (damage to the heart muscle) and keratitis, which leads to blindness . Subacute sclerosing panencephalitis is considered an extremely severe complication. The prefix “pan” means “solid”, that is, it is a continuous inflammation of brain tissue - a disease leading to loss of vital functions and early death. And it occurs in children with measles under two years of age. As studies have shown, it was vaccination that contributed to a sharp decrease in the incidence of panencephalitis.
It is also important to know that there is no single antiviral drug against measles. Treatment of measles is nonspecific, it is aimed at eliminating individual symptoms.
The danger of measles also lies in its high contagiousness and high susceptibility. The disease is transmitted by airborne droplets; one person can infect 18 others in contact with him. The measles susceptibility index is 0.96. People who have not previously had measles and have had direct, even short-term contact with a sick person, almost all become ill, regardless of age.
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How does measles occur in children and how do signs of the disease appear?
There are different degrees of the disease - mild, moderate and severe. However, in children, measles most often develops in moderate and severe forms, and is especially severe in children under two years of age. The mild form at the onset of the disease is quite dangerous, when the child has a slight fever, a slight cough, and can still attend kindergarten or school. If the disease is not tracked in time, such a child can infect all other unvaccinated children in the kindergarten or in the entire school (due to its high contagiousness).
The main symptoms of measles are fever, weakness, catarrh of the upper respiratory tract, inflammation of the eyes, and rash. The disease occurs cyclically. The first stage is catarrhal, when the main symptoms appear - cough, runny nose, fever, general weakness, conjunctivitis with photophobia and a “semolina”-type rash on the oral mucosa (the so-called Belsky-Filatov-Koplik spots), characteristic only of measles. Before the second stage begins, the temperature usually drops.
“After 3-4 days, the next stage begins - the period of rash. This is the peak of the disease, in which all the symptoms increase sharply, the temperature rises again and can reach 40 degrees or more, the cough intensifies, the lips and eyelids swell, the eyes water or fester, it hurts to look at the light, says Nina Yandraykina. “And a rash appears, starting from the area behind the ears and from the cheeks, then going down to the neck and chest, and the next day - to the entire torso, and on the third day also to the limbs. This stage lasts on average 3–4 days. Then comes the third stage - the period of pigmentation, when the rash gradually turns pale, disappears within 7-10 days, turning into light brown spots and accompanied by pityriasis-like peeling on the body, the temperature normalizes, and appetite appears.”
But, despite the improvement in the condition, the pigmentation phase is characterized by the presence of “anergy”, that is, a decrease in immunity. Therefore, those recovering from measles should be especially protected from contact with other infections and from physical and emotional stress.
pskovgorod.ru / City of Pskov
Measles, clinical picture and course of the disease
The disease begins with an incubation period, which on average in children ranges from 10 to 14 days. During this period, the virus develops latently in the body, so the only criterion by which one can suspect that a child could have become infected is if a measles quarantine was declared at school or kindergarten. In this case, you can protect other children and members of your family who have not been vaccinated against measles by separating them from the child after the 8-9th day of the incubation period for a week (or more if the child is sick).
The initial period of measles disease is catarrhal. Since during this period the disease begins acutely with an increase in body temperature to 39 degrees C, a dry, obsessive cough appears in combination with severe conjunctivitis - redness of the mucous membranes of the eyes and “photophobia”. Bright light greatly irritates a person with measles. Cough in the initial period of measles tends to intensify within 3-4 days; in children under 5 years of age there is a high probability of hoarseness, which is the first sign of obstructive laryngitis (in the old terminology - false croup). A cough in a patient with measles is accompanied by a runny nose with copious mucous, and then mucopurulent discharge from the nose, severe general intoxication: weakness, disturbed sleep and decreased appetite.
By the 3rd – 4th day of the disease, the face of a patient with measles takes on a swollen appearance with “swollen” eyelids, red conjunctivae, lacrimation and possible purulent discharge from the eyes.
A typical symptom of measles is described, the so-called Filatov-Koplik spots, which appear at the end of the catarrhal period and 1-2 days before the first skin rash. Filatov-Koplik spots are small whitish-gray dots surrounded by a halo of hyperemia. They are located in the mouth, on the mucous membrane of the cheeks, opposite the molars. In addition to Filatov-Koplik spots in the mouth, red spots may appear on the soft palate, which are called measles enanthema.
The period of rash begins on the 4th – 5th day of the disease with the appearance of maculopapular rash elements on the skin. During this period, intoxication, as a rule, intensifies; the temperature, after some decrease at the end of the catarrhal period, rises again to high numbers. Measles is characterized by a “staged rash.” The first elements of the rash appear behind the ears, on the scalp, as well as on the face and neck. On the 2nd day, the rash covers the torso and arms; on the third day from the onset of the first rash, measles exanthema spreads to the lower part of the torso and legs. The measles rash can be described as bright pink and tends to coalesce into large lesions. The extinction of the elements of the rash also occurs gradually in the same order in which they appeared. In case of late diagnosis, it must be borne in mind that old elements of measles exanthema first turn pale, then acquire a brown color, and remain in this form for quite a long time, up to 10 days. During this final period of measles, the period of pigmentation, fine peeling is also observed on the skin.
In the final period of measles, the symptoms of intoxication and fever subside, and recovery occurs.
How long does the effect of the measles vaccine last?
“It is believed that the duration of immunity after vaccination is comparable to that during a natural infection, which means lifelong,” says Nina Yandraykina. “But such conclusions require further observations, since the mass use of measles vaccine began only in 1965–1968. There are other data. According to the researchers, depending on the strain of the virus used in the vaccine, the effect lasts on average from 12 to 18 years after the second vaccination. However, some authors provide data that even after 26–33 years, the effect of vaccination continues to operate, and a person has antibodies in protective concentrations.”
A little theory
Even “at the dawn” of vaccination, it was known that THOSE who HAVE NOT developed specific (against a specific disease) immunity NATURALLY SHOULD BE VACCINED. Vaccinations are contraindicated for those who already have natural immunity against the disease! Often a healthy person has a high level of antibody titers to the infection. Before any vaccination, it is necessary to be tested for the presence of antibodies (immunity test)
The presence of internal immunity to infection may be due to the fact that the development of immunity (antibodies) occurs not only through vaccinations (this method, by the way, is very aggressive and causes a lot of controversy), but also in softer ways - through random short-term contacts with sick people. Any doctor will confirm that NOT EVERYONE gets sick when in contact with a patient, even the most contagious (infectious) disease! Why? Yes, because immunity against infectious diseases can be developed unnoticed (the same “vaccination”, but without artificial vaccines!). Antibody titers just show that an encounter with an infection has occurred, and that there is protection (this is exactly what is called “specific immunity”).
I repeat. Antibodies CAN be produced: a) during acute infection; b) when a healthy person encountered an infection and “overcame” it “unnoticeably” - i.e. “natural grafting” occurred. c) after the administration of a vaccine (inoculation). The main thing is the production of antibodies (whereas they say, “the vaccination has taken place”). How many antibodies are produced and how long they last is purely individual. It happens that a person gets ill with whooping cough three times in his life (that is, sufficient immunity is not developed even after the illness), and it happens that “imperceptibly developed immunity” (either after vaccination or without vaccination) protects against whooping cough for life .
Are there possible side effects of the measles vaccine for a child?
Reaction to a vaccine: can it bring unpleasant consequences? This is a question every loving parent asks. Nina Yandraykina agrees that the measles vaccine for children, like others, can have side effects:
“Most often, these are acceptable adverse reactions, when some children develop rashes, cough, runny nose or fever between the fifth and 20th day. But all these symptoms do not last long (2-4 days) and disappear on their own.”
The most unpleasant consequences of measles vaccination for children are high fever (especially dangerous for children prone to febrile convulsions) and allergic reactions to vaccine components, in particular to chicken or quail egg white. These unpleasant reactions can be avoided by observing contraindications to vaccination and taking antipyretic or antiallergic medications.
How to determine whether vaccination is needed or not
The situation with vaccinations is very simple: if it is possible not to do it, then it is better not to do it, because the consequences can be very diverse...
On the other hand, if a vaccination needs to be done, then it is better to do it, since it often happens that the vaccination was done, but the antibodies have not developed, immunity has not formed or has weakened over time.
Before vaccination against measles, it is advisable to conduct a blood test for antibodies (strength of immunity against measles). Everything is logical: if the analysis shows a sufficient amount of antibodies to measles, the vaccination is not done (because antibodies “say” that there is protection against measles in the body). Almost all people have a natural antibody titer that is quite high and literally 9-15% of the total amount is vaccinated.
Who and where can get vaccinated?
As a rule, if the child is 12 months old, preference is given to the shoulder or hip; at six years of age, the injection is given to the shoulder or shoulder blade. Vaccination against measles is necessary for all susceptible children, that is, all children one year and older who have not had measles and have not been vaccinated previously.
Measles vaccination for children is included in the national vaccination calendar and can be done in any medical institution where there is a pediatrician and a vaccination office. Before the procedure, the child must be examined by a doctor, and all necessary information about the child is collected.
If a child has previously suffered a mild acute illness, for example, seasonal acute respiratory infections, then at least two weeks should pass before vaccination. If the baby has had bronchitis or pneumonia, then the vaccine is given no earlier than a month later.
Immune status for measles
April 12, 2021
The only measure to prevent measles is immunization.
As part of the national calendar of preventive vaccinations, the following is carried out:
at 12 months – vaccination (first vaccination in life), at 6 years – revaccination (second vaccination).
Child aged 1 year to 5 years 11 months. 29 days must have one vaccination against measles, aged 6 years to 17 years 11 months. 29 days two vaccinations against measles.
If a person has had measles, he is not subject to measles vaccinations during his life. Those who have had measles have lifelong immunity.
An adult is not subject to vaccination if there is evidence of two measles vaccinations given at any age, including in childhood.
The following adults are subject to vaccination against measles: those who have not been sick, not vaccinated, vaccinated once, who do not have information about vaccinations: the entire population under 35 years of age (inclusive), regardless of profession, from 36 to 55 years of age (inclusive), belonging to risk groups.
Risk groups include employees of medical and educational organizations, trade, transport, public utilities and social spheres; persons working on a rotational basis and employees of state control bodies at checkpoints across the state border of the Russian Federation.
Employees of medical organizations (without age restrictions) are recommended to have two vaccinations against measles or information about having had measles, confirmed by documentation or serological methods.
As part of the calendar of preventive vaccinations for epidemic indications, contact persons without age restrictions from foci of suspected measles who have not previously been ill, have not been vaccinated and do not have information about preventive vaccinations against measles or have been vaccinated once are subject to vaccination within 72 hours.
In the virological research laboratory of the Center for Hygiene and Epidemiology in the Republic of Bashkortostan, you can check your immune status for measles.
What is delivered for research: blood serum from a vein in the amount of 1 ml., delivery at a temperature of 2 to 8 ° C.
The price list for serological tests for immunity using ELISA in blood serum is 254 rubles 40 kopecks.
A positive test result for measles immunoglobulin G confirms protection against measles. A negative and questionable result indicates that a person can become infected with measles and needs to be vaccinated.
Indications for an individual study of immune status: loss by an adult of records in the medical records of measles in childhood; incomplete data on vaccinations (lack of series and name of the vaccine); the presence of factors that contribute to a decrease in immunity (hormone therapy, chemotherapy, anthelmintic drugs, HIV infection), occupational risk of infection due to contact with infectious patients (medical workers, etc.).
The research results must be included in the “Certificate of Preventive Vaccinations”, form No. 156/у section “Serological studies to determine the strength of immunity.”
